[Purpose] The aim of this study was to clarify a possible relationship between dysphagia and the time use of in-home aged persons.
[Subjects] Thirty-nine aged persons who utilized home-visit rehabilitation were recruited for this study (mean age: 80.7±7.5 yrs, 18 males and 21 females).
[Methods] Evaluation of their feeding status (① Eating status, ② Food shape, ③ Presence or absence of choking, ④ Mealtime, ⑤ History of pneumonia), feeding/swallowing function test (⑥ RSST, ⑦ WST), and ADL assessment using the Barthel index were performed to determine the proportion of time in a sitting posture for mealtimes to the total daily times in lying and sitting postures as an index of time use. The subjects were divided into two groups for comparison of the individual items mentioned above, that is, a group comprising subjects with an established diagnosis of dysphagia, “Dysphagia group,”and another group of those with other diseases, “Non-dysphagia group.”
[Results] When comparing the feeding status and swallowing function, a significant difference was observed in the eating status, food shape, history of pneumonia, mealtime, presence or absence of choking, water-drinking test and the Barthel index. Furthermore, a significant difference was also observed in the total lying and sitting times as an index of time use.
[Discussion] Because potential factors that possibly affect the swallowing function in aged persons vary widely, it is thus necessary to take systemic causes into consideration simultaneously. Furthermore, it is also required to grasp adequately their lying status rather than the feeding status because of the reported high incidence of silent aspiration at night in aged persons. Since the total lying time implies the sum of lying time per day, it thus seemed important to control this time. From the results of this study, it was suggested that not only an ADL assessment but also an evaluation of time use is important in aged persons with dysphagia.
[Purpose] Head rotation is one of the postural interventions available for patients with dysphagia, reducing post-swallow residue in the pharynx by head rotation towards the weakened side. However, maintaining the head in a rotated position for an entire meal may lead to fatigue, so a comfortable feeding posture with optimal head rotation is desired. In the present study, we systematically examined the effects of various head rotation angles on the side of bolus flow through the hypopharynx in healthy adults.
[Methods] Videofluorography (VF) at an anterior-posterior projection was performed on 30 healthy volunteers (12 male and 18 female, mean age 26 years old) during the ingestion of 3 ml liquid barium. Head rotation angles were classified as no rotation (zero degrees; control), 15, 30, and 45 degrees, and maximum rotation (right side, 61.9±4.4 degrees; left side, 66.7±6.2 degrees) for both right and left sides. The side of bolus flow through the hypopharynx during the pharyngeal stage of swallowing was then evaluated on digitized VF images. We tested if bolus flow on the rotated side was altered by different head rotation angles.
[Results] The barium passed through both sides of the hypopharynx with comparable incidence in all subjects with no head rotation. With 30 degrees of head rotation, the barium passed through the rotated side of the hypopharynx in seven subjects (23%) with right rotation, and 12 subjects (40%) with left rotation. The percentage of subjects with no barium passage through the rotated side was significantly lower with 30 degrees of head rotation or more than with control (p＜0.01). With maximum rotation, the bolus passed through the rotated side of the hypopharynx in only one subject (3.3%) with right rotation and in four (13%) with left rotation.
[Conclusion] The present study demonstrated that the percentage of subjects with bolus passage through the rotated side significantly decreased with 30 degrees of head rotation or more. Postural interventions for dysphagic individuals should have adequate safety, comfort, and effectiveness during feeding posture. In clinical settings, the efficiency of head rotation is usually determined with VF or videoendoscopy. The findings in this study imply that 30 degree head rotation would be deserved to be evaluated its efficiency during instrumental examinations for swallowing.
[Objective] We aimed to evaluate the rationality of the proposed standard regulations of “Foods for people with difficulty in swallowing” compiled as a part of the “Food for Special Dietary Uses,” formulated by the Ministry of Health, Labour and Welfare in Japan in 2008, by comparing the subjective opinions of clinicians with the findings of objective measurements.
[Methods] We investigated the correlation between rheological measurements and clinicians’ subjective evaluation about the jelly, which was prescribed to people with severe dysphagia. Fifty-two clinicians who had treated cases of dysphagia for at least 1 year participated in the study. Eight jellies with different textures were used. The clinicians were required to assign the jellies to the level of dysphagia either to Standard Regulation levels I, II, or III or to “no suitable level” on the basis of their subjective evaluation. The physical properties of the jellies were measured using texture profile analysis, and the ratios of syneresis were measured.
[Results] The findings of the comparison were as follows: the values of the lower limit of hardness mentioned in Standard Regulation I and adhesiveness mentioned in Standard Regulations I and II were too high and that the value of the upper limit of hardness mentioned in Standard Regulation II was too low. Compared to other jellies, the jellies that were assigned to “no suitable level” were more frequently evaluated as “seems to undergo syneresis” or “liquefy in the mouth.”
[Conclusion] The findings of our study suggested that (1) the lower limit of hardness mentioned in Standard Regulation I should be revised to 2,500 N/m2, (2) the upper limit of hardness mentioned in Standard Regulation II should be revised to 15,000 N/m2, and (3) no lower limit should be assigned to adhesiveness in all the levels of the Standard Regulation. Further research is required to determine a method for measuring the ratios of syneresis of jellies and to apply the findings of this method to determine the diets for individuals with difficulty in swallowing.
[Purpose] Bolus preparation is important to reduce the risk of aspiration. We previously reported that it is possible to evaluate bolus preparation for swallowing in the pharynx using videoendoscopy. In other previous studies, which evaluated the bolus outside of the mouth or pharynx, it has been reported that the number of chewing strokes influenced bolus preparation. This study examined the relationship between the number of times the bolus was chewed and the swallow threshold bolus observed in the pharynx using videoendoscopy.
[Methods] Thirty healthy dentulous adults participated in this study. Rice in two colors （white and green） was used as the examination foods. The subjects were instructed to eat mouthfuls of the rice with two colors in their usual manner. We evaluated the bolus in the pharynx using videoendoscopy from the perspective of grindability, mixing and aggregation and counted the number of chewing strokes before swallowing the bolus.
[Results] The bolus immediately before swallowing showed a high degree of aggregation and relatively low degrees of grindability and mixing. The degrees of grindability and mixing increased in association with the increase in the number of times the rice was chewed. There were correlations between the number of chewing strokes and the grindability or mixing. The degree of aggregation was high despite the number of times the rice was chewed. There was no correlation between the number of chewing strokes and the aggregation.
[Conclusion] These findings indicated that the number of chewing strokes influences grindability and mixing of bolus similar to the findings of the previous studies. At the swallow threshold, the bolus showed a high degree of aggregation even when there were poor degrees of grindability and mixing due to a low number of chewing strokes. These results suggested that the swallow threshold depends on the degree of aggregation, not the degrees of grindability and mixing.
For mastication and/or swallowing disorders in patients, the solid component of food is softer and/or in smaller pieces, and the liquid component is thicker. We usually use subjective words to communicate the level of the texture and consistency, but their levels are not certain. To objectify the level communicated by words related to texture and consistency, we conducted a questionnaire survey.
One hundred and sixty-five dietitians who work in hospitals or in facilities for the elderly or the physically challenged returned the questionnaire. They marked a visual analog scale for words and photographs related to the size of pieces, hardness and viscosity.
We quantified the subjective impression of the words and photographs related to the texture and consistency. The values of those items make it possible to classify meals for dysphagia. However, the following facts were also found: 1) The variance for some words was wide. 2) There were multiple words for the same level of texture and consistency. This may cause confusion when they report patient information to other dietitians. This data may be a useful reference for recognizing the current status and problems.
Dermatomyositis (DM) is an autoimmune disease characterized by inflammation primarily on the striated muscle as well as a skin rash. Involvement of the pharyngolaryngeal muscles causes swallowing and articulatory disorders. A 74-year-old male with mild dysphagia was diagnosed as DM and hospitalized to undergo steroid therapy. During hospitalization, he was referred to the Department of Otorhinolaryngology with complaints of left hearing loss. Nasopharyngeal carcinoma was found in his epipharyngeal region (T2N1M0) and treated using chemoradiation therapy. After the treatment, his dysphagia became worse. A videofluoroscopic examination of swallowing was performed to evaluate his swallowing function and revealed a stretch disorder at the esophageal orifice. A balloon catheter was applied through the nose to dilate the cricopharyngeal sphincter. The position of the balloon was confirmed using endoscopy. The cricopharyngeal sphincter was successfully dilated by the balloon method. It was safe to perform the balloon method for the chronic stage of cricopharyngeal dysphagia using endoscopy. As a conservative therapy, the balloon method should be employed before surgery.